This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. Patients hospitalized with acute decompensated heart failure if they develop cardiorenal syndrome as defined by ain increase in serum creatine of or equal to .3 mg per deciliter from baseline while demonstrations signs and symptoms of persistent congestion. The trial is randomized to stepped pharmacologic care verses ultrafiltration. The primary endpoint is a change in the bivariate endpoint assessment of weight and change in creatinine within 96 hours. The goal of the study is to test whether ultrafiltration compared to stepped pharmacologic loop diuretic care will result in improved renal function and relief of congestion in patients hospitalized with acute decompensated heart failure and Cardio renal syndrome.